Fillable HDRHA Southern Slide EF 2021 2 (Harrel Show Secretary)

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HDRHA Southern Slide EF 2021 2 (Harrel Show Secretary)

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Heart of Dixie Snowbird Slide ENTRY # _________
Acct Name: _________________________________ Trainer: __________________________________
(Person Responsible for Paying)
NRHA Horse’s Name _____________________________________ Comp Lic # ______________ S G M
Horse’s Barn Name __________________________________ Yr. Foaled: _______
Owner’s Name ______________________________________ NRHA # ________________ G P NP Y L
Rider’s Name ______________________________________ NRHA # ________________ P NP A Y L
PAYEE: Rider or Owner NO ADDRESS….NO SSN#.....NO PAYCHECK
Address____________________________________________ City ___________________________ State______ Zip ___________
Phone (______) __________________________ E-mail ________________________________________________________
Friday, Jan29 START8:00AM
1
st
1700 Nov Hor Op L1*(500) 50 35 ________________________ NRHA #__________ 3
1750 Nov Hor Op L2* (500) 50
1775 Nov Hor Op L3* (500) 50
1800 Nov Hor NP L1* (500) 50
1850 Nov Hor NP L2*(500) 50
1875 Nov Hor NP L3*(500) 50
2
nd
5300 Rookie L1* (JP) 20 20 ________________________ NRHA # _________ 6
5301 PT Rookie* (JP) 20
5310 Rookie L2* (JP) 20
3
rd
1100 Open* (1000) 100 45 ________________________ NRHA # __________ 10
1200 Int Open* (500) 50 35
1301 Ltd Open* (500) 50 35
1350 Rookie Pro* (JP) 50 35
2100 Open Derby L4 (4000) 280 65 _______________________ NRHA#__________
2102 Open 7 up Mat L4(1500) 105 45
2103 Open 7 UP Mat L2(500) 50 35
2300 Open Derby L2 (2000) 140 60
2325 Open Derby L1 (1000) 70 45
Saturday, Jan 30 Start 8:00AM
1
st
1700 Nov Hor Op L1**(250) 25 25 ________________________ NRHA #__________ 4
1750 Nov Hor Op L2** (500) 50 35
1775 Nov Hor Op L3 (500) 50 35
1800 Nov Hor NP L1** (250) 25 25
1850 Nov Hor NP L2** (500) 50 35
1875 Nov Hor NP L3 (500) 50 35
2
nd
3100 Youth 13 & U* 10 0 ________________________ NRHA # __________ 8
3200 Youth 14-18* 10
3
rd
3500 Short Stirrup* 10 0 _______________________ NRHA#__________ B
4
th
9501 HDRHA Grn Reiner 1 30 0 _______________________ NRHA# __________ 6
9502 HDRHA Grn Reiner 2 30
10001 Green Reiner* L2 30
10002 Green Reiner* L1 30
5
th
1400 Non-Pro* (1000) 100 45 ________________________ NRHA # __________ 12
1500 Int NP* (300) 30 25
1601 Ltd NP* (200) 20 20
1650 PT Non-Pro* (100) 10 10
2400 NP Derby L4 (4000) 280 65
2402 NP Mat 7up L4 (1500) 105 45
2403 NP Mat 7up L2 (500) 50 35
2600 NP Derby L2 (2000) 140 60
2625 NP Derby L1 (1000) 70 45
5121 NP Masters* (JP) 20 20
WARNING: Under Georgia law, an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant
to Chapter 12 of Title 4 of the Official Code of Georgia Annotated. I further understand that all horses must be stalled due to facility requirement. Horses are not allowed to be tied to trailers for extended periods
or overnight. I will abide by this requirement.
RELEASE OF LIABILITY: By making an entry in this show, participant agrees to release Heart of Dixie Reining Assc. and Harrel Show Secretary from liability resulting from risks inherent in equine activities.
CREDIT CARD: By signing this form you agree to pay charges for service with above mentioned CC information.
HORSES NAME ___________________________________________________________ ENTRY ______________
SUNDAY Jan 31 Start 8:00AM
1
st
3100 Youth 13 & U** 10 0 _______________________ NRHA# __________ 10
3200 Youth 14-18** 10
2
nd
3500 Short Stirrup** 10 0 _______________________ NRHA# __________ A
3
rd
9501 HDRHA Grn Reiner 1 30 0 _______________________ NRHA# __________ 8
9502 HDRHA Grn Reiner 2 30
10001 Green Reiner** L2 30
10002 Green Reiner** L1 30
3
rd
5300 Rookie L1** (JP) 20 20 ________________________ NRHA # _________ 11
5301 PT Rookie** (JP) 20 20
5310 Rookie L2** (JP) 20 20
4
th
1400 Non-Pro** (500) 50 35 ________________________ NRHA # __________ 5
1500 Int NP** (300) 30 25
1601 Ltd NP** (200) 20 20
1650 PT Non-Pro** (JP) 20 20
5121 NP Masters** (JP) 20 20
5
th
1100 Open** (500) 50 35 ________________________ NRHA # __________ 2
1200 Int Open** (300) 30 25
1301 Ltd Open** (250) 25 25
1350 Rookie Pro** (JP) 25 25
FOR OFFICE USE ONLY (Only one Judges Fee for Concurrent Classes – Highest fee applies)
Entry fee total - - - - - - - - - - - - - - - - =________ CHK# ________
Judges fee total - - - - - - - - - - - - - - - - =________ CASH________
Office fee $35.00 - - - (Youth Only Classes-office fee free) = 35.00 CC_________
- =________ Amount $_________
Stall _____ X $160 For Show (1/28-1/31) - - -
Photo & Video Fee $60 - - - - - - - - - - - -
- -
CC Approval Code _______________
NRHA Fee x$7/horse- - - - - - - - - - - - - - - - - - -
= 60.00
=________
Paid Warm Ups _______ x $40- - - - - - - - - - - - - - = ________
CC up charge fee 5% ________
Misc ____________________________ - - - - - - - - =________
FINAL TOTAL = _______
_________________________________________________________________________________ Date _____________________________________
Signature
CC _______________________________________________________________ Exp____ _______________________ CVC__________ Zip ______________
Checks payable to:
Heart of Dixie
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HDRHA Southern Slide EF 2021 2 (Harrel Show Secretary)

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Completed 6 May 2021

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